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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES _ <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> JoE C(� S ��o x)oc C'(�s�►� �o <br /> FACILITY ADD / i'/1L� Rd SITE PHONE A with AREA CODE <br /> L t� <br /> T CITY 11 I �TWA�TB LP LODE A of TANKS /j <br /> Y S70C k.4 OV` et SIiE h <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P n C XC.4(/A4 O " fir. l 1�L-1iG1 F1 Y9 <br /> L <br /> I MAILING�RE55 O YD APPLICANT �jIONE A 41iN AREA CODE 7 <br /> Cn Us <br /> A <br /> N CITY f E it CODE TYPE of APPLICATION <br /> I A �� C CLOSURE, INSTALLATION, ste. <br /> TOTAL <br /> A1986 1 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) • S100.00 <br /> I S <br /> E TANK FEE 550.00/TANK (prior to Jamary 1,1991) 5170/TANK (after January 1, 1991) <br /> F / Tanks 1 1986 1 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 <br /> A (multiply T5—fee for <br /> Yi1 <br /> C each year app cable) <br />' I <br /> Ll STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H 6 S Code, Section 25287 <br /> 1 <br /> T / Tanks x 556.00 1986 through 1990 7991 through 1996 <br /> Y (enter amount and year) <br /> f <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. /(s) 01CP <br /> L CLOSURE FEE $53.00 per hour (3 hours ml nimus per TANK) A �1ANK(a) X $159.00 • 3/ <br /> 0 <br /> U TEMPORARY CLOSURE (A one-time permit, for review/Inspections) TANK I.D. A(s) <br /> R <br /> E TEMPORARY CLOSURE FEE = $150.00 each TANK A TANK(s) _ X $150.00 • S <br /> P PLAN CHECK (Install. Plan Review i Construction Inspections) TANK I.D. /(s) <br /> L <br /> Al PLAN CHECK FEE - $53.00 per hour (8 hours minimus per Facility) • S424.00 miniaxm PAY C K <br /> R REPAIR FEE (workplan review S construction inspections) TANK LD. /(s) <br /> P TANK REPAIR FEE = $53.00 per hour (3 hours minimWTANK) A TANK(s) X $159.00 <br /> A <br /> R PIPING REPAIR FEE = $53.00 per hour (3 hour minimus per facility = 1159.00) PUBLIC HEAL]' <br /> MTRANSFER FEE • 220.00 UNAUTHORIZED RELEASE EVALUATION • S53.00/hr f <br /> 1 <br /> 4—COMSULTATION fEE 553.00/hr SAMPLING INSPECTION FEE = S53.00/hr S <br /> TOTAL DUE 1 <br /> .ra¢f,,F.;,I.LE,,,US_�m4NlTmmm!,:e!n: mimml <br /> anm:aA�!!.m =:n:R.�: nnn.uun_C1,��r l�u m::mm!n . nm . ivx ��va5ini, nWEIV � n,I'lb'x,ff U <br /> Rf /6..:n,!!rR.:l <br /> rmn u ! <br /> H.sxr:!mmmmm�n=.m!nnmu_!.: .m!!mr�m!mrmr.mmmna!!mmrm!!..a mmmsmmmnnmmm!.mn5i.dmr�o: mumrtlirmo!m!rr im!�nnm mmr nr.(nn(xalnn! : .JRmR/m1nmmm/m!fiim!:rmrmm;;.11 <br /> ,..:.: �I;.� � ,.;;, ._;,,r nen rmnmmmn�:nnmm�u�i rimmi:!mmmiiNurmmunnmam!n�n.!� ! �! nrnn;nu;urmnnlli1111111111'Ir!i:iJgJJL;ril;l!i4:!II <br /> ......_..............r :.,:..a,:_ura�in,�iiui wuiaur.nn.�� <br /> EH 23 032 (REV 4/8/91) 1t C �>hL` '3 Page 11 <br /> �r �s <br />